Zusammenfassung
Der Beitrag gibt eine Übersicht zur Entwicklung der Fachdebatte um den sexuellen Missbrauch an Kindern. Nach einer Einführung in unterschiedliche Definitionen werden Angaben zur Häufigkeit gemacht. Es können, Abhängigkeit von der jeweiligen Definition, bei Mädchen zwischen 6 % und 25 % und bei Jungen 2 % – 8 % zu den Betroffenen gezählt werden. Psychische Folgen des sexuellen Missbrauchs werden auf der Basis der Forschungsliteratur dargestellt. Notwendige und in Bezug auf die Folgen entbehrliche diagnostische Maßnahmen werden diskutiert. Neuere neurobiologische Befunde zu den Auswirkungen von Traumata und zur Traumaverarbeitung werden ebenfalls vorgestellt. Abschließend erfolgt eine Darstellung der Grundsätze zur Beratung von Betroffenen und eine Übersicht über evidenzbasierte Therapieansätze (Psychotherapie und Pharmakotherapie) der Folgeprobleme. Ein Fazit stellt mögliche Schlussfolgerungen für die Praxis und die klinische Forschung in Deutschland dar.
Abstract
The present paper gives an overview on the development of professional discourse on sexual abuse over the last 20 years in the field of child protection. After the introduction, definitions from different professional perspectives (civil law, criminal law, psychotherapy, counseling, etc.) are given. Based on these definitions an epidemiological range of prevalence figures is described. In the literature, rates ranging from 6 to 25 % in girls and 2 to 8 % in boy as victims of sexual abuse can be observed. Psychiatric consequences of sexual abuse are described based on an overview of the literature. Diagnostic approaches to posttraumatic problems are discussed and distinguished from obsolete measures. Some neurobiological findings are presented. Finally the foundations of counseling, psychotherapy and pharmacotherapy of behavioral of symptoms and PTSD are discussed on the bases of a literature review of controlled clinical trials. In conclusion, further developments in psychotherapy and research are discussed for the German practical child protection field.
Literatur
Behl LE, Conyngham HA (2003) May PF Trends in child maltreatment literature. Child Abuse Negl 27(2):215–229
Munro E (1999) Common errors of reasoning in child protection. Child Abuse and Negl 23(8):745–758
Fegert JM, Berger C, Klopfer U et al. (2001) Umgang mit sexuellem Missbrauch. Institutionelle und individuelle Reaktionen. Forschungsbericht. Votum, Münster
Fegert JM, Wolff M (2006) Sexueller Missbrauch durch Professionelle in Institutionen, 2nd edn. Juventa, Münster
Landolt MA (2003) Die Bewältigung akuter Psychotraumata im Kindesalter. Praxis Kinderpsychol Kinderpsychiat 52:71–87
Engfer A (2005) Formen der Misshandlung von Kindern – Definitionen, Häufigkeiten, Erklärungsansätze. In: Egle UT, Hoffmann SO, Joraschky P (Hrsg) Sexueller Missbrauch, Misshandlung, Vernachlässigung. Erkennung, Therapie und Präven tion der Folgen früher Stresserfahrungen. Schattauer, Stuttgart, S 3–19
Helfer ME, Kempe RS, Krugman RD (2002) Das misshandelte Kind. Körperliche und psychische Gewalt, sexueller Missbrauch, Gedeihstörungen, Münchhausen-by-proxy-Syndrom, Vernachlässigung. Suhrkamp, Frankfurt am Main
Schechter M, Roberge L (1976) Child sexual abuse, in chid abuse and neglect: the familiy and the community. Cambridge Ballinger, pp 127–142
Terr L (1991) Childhood traumas: an outline and overview. Am J Psychiatry 148:10–20
Putnam FW (2003) Ten-year research update rewiew. Child sexual abuse. J Am Acadamy Child Adolescent Psychiatry 42(3):269–278
Paolucci E, Odone ML, Genuis M, Violato C (2001) A meta-analysis of the published research on the effects of child sexual abuse. J Psychol: 17–36
Spataro J, Mullen PE, Burgess PM et al. (2004) Moss, impact of child sexual abuse on mental health: prospective study in males and females. Br J Psychiatry 184(5):416–421
Perry B (2001) The neurodevelopmental impact of violence in childhood. In: Schetky D Benedek E (eds) Textbook of child adolescent forensic psychiatry. American Psychiatric Press, Inc.: Washington, D.C, pp 221–238
De Bellis M, Thomas L (2003) Biologic findings of post-traumatic stress disorder and child maltreatment. Current Psychiatry Reports 5(2):108–117
Nemeroff C (2004) Neurobiological consequences of childhood trauma. J Clin Psychiatry 65 (Suppl 1):18–28
Lesermann J (2005) Sexual abuse history: prevalence, health effects, mediators, and psychological treatments. Psychosom Med 67(6):906–915
Brown J, Cohen P, Johnson JG, Smailes EM (1999) Childhood abuse and neglect: specifity of effects on adolescent and young adult depression and suicidality. J Am Acad Child Adolesc Psychiatry 38:1490–1496
Fergusson DM, Lynskey MT, Horwood JL (1996) Childhood sexual abuse and psychiatric disorder in young adulthood: I. Prevalence of sexual abuse and factors associated with sexual abuse. J Am Acad Child Adolesc Psychiatry 34:1355–1374
Cullen B, Smith P, Jeann B, Haaf RA (2000) matched cohort comparison of a criminal justice system‘s response to child sexual abuse: a profile of perpetrators. Child Abuse Neglect 24:569–577
Murray J (2000) Psychological profile of pedo philes and child molesters. J Psychol 134:211–224
Christiansen A, Thyer B (2003) Females sexual offenders: a review of empirical research. J Human Behavior Social Environment 6:1–16
Busse D, Steller M, Volbert R (2000) Sexueller Missbrauchsverdacht in familiengerichtlichen Verfahren. Forschungsbericht. Praxis der Rechtspsychologie 10 [Sonderheft 2]
Wetzels P (1997) Zur Epidemiologie physischer und sexueller Gewalterfahrungen in der Kindheit. Forschungsbericht Nr. 59 des Kriminologischen Instituts Niedersachsen, Hannover
Wetzels P (1997) Prävalenz und familiäre Hintergründe sexuellen Kindesmissbrauchs in Deutschland: Ergebnisse einer repräsentativen Befragung. Sexuologie 2(4):89–107
Fegert JM (2001) Qualität der Begutachtung sexuell missbrauchter Kinder. Fachliche Standards in juristischen Verfahren. Luchterhand, Neuwied
Johnson JG, Cohen P, Brown J et al. (1999) Childhood maltreatment increase risk for personality disorders during early adulthood. Arch Genetic Psychiatry 56:600–606
Bagley C, Mallick K (2000) Prediction of sexual, emotional and physical maltreatment and mental health outcomes in al longitudinal cohort of 290 adolescent women. Child Maltreatment 5:218–226
Fergusson DM, Horwood JL, Lynskey MT (1996) Childhood sexual abuse and psychiatric disorder in young adulthood:II. Psychiatric outcomes of childhood sexual abuse. J Am Acad Child Adolesc Psychiatry 35(10):1365–1374
Wise LA, Zierler S, Krieger N, Harlow BL (2001) Adult onset of major depressive disorder in relation to early life violent victimization. A case-controll study. Lancet 358:881–887
Fegert JM (2001) Begutachtung sexuell missbrauchter Kinder. Fachliche Standards im juristischen Verfahren. Luchterhand, Neuwied
Remschmidt H, Schmidt MH, Poustka F (2006) Multiaxiales Klassifikationsschema für psychiatrische Erkrankungen im Kindes- und Jugendalter nach ICD-10 und DSM-IV, Vol. 5. Huber, Bern
Manly J, Jungmeen E, Rogosch F, Cichetti D (2001) Dimensions of child maltreatment and children‘s adjustment:contributions of developmental timing and subtype. Dev Psychopathol 13:759–782
Cichetty D, Manly J (2001) Operationalizing child maltreatment:Developmental processes and outcomes(Editorial). Dev Psychopathol 13:755–757
Cichetty D, Rogosch F (2001) The impact of child maltreatment and psychopathology on neuroendocrine functioning. Dev Psychopathol 13:783–804
Kaufman J, Plotsky P, Nemeroff C, Charney D (2000) Effects of early adverse experiences on brain structure and function:clinical implications. Biol Psychiatry 48:778–790
Bremner J, Narayan M, Staib L et al. (1999) Neural correlates of memories of childhood sexual abuse in women with and without posttraumatic stress disorder. Am J Psychiatry 156(11):1787–1795
Streeck-Fischer A (2006) Trauma und Entwicklung. Schattauer, Stuttgart New York
Braun G, Wolters D (1991) Das große und das kleine nein. Verlag an der Ruhr, Mühlheim
Harris RH, Emberley M (2002) Total normal. Was du schon immer über Sex wissen wolltest. Beltz, Weinheim
Achilles I, Bätz R, Bartzok M (2005) Sexualpädagogische Materialien für die Arbeit mit geistig behinderten Menschen. Juventa, Weinheim
Fegert JM, Fetzer A, König C et al. (2006) Ich bestimme mein Leben und Sex gehört dazu. Geschichten zu Selbstbestimmung, Sexualität und sexueller Gewalt für junge Menschen mit geistiger Behinderung. Arbeitsbuch und Begleitband. (im Druck)
Darvill W, Powell K (2001) Wie kläre ich mein Kind auf? Tipps und Gesprächshilfen. Heyne, München
Cohen J, Mannarino AP (1996) A treatment study for sexually abused preschool children:initial findings. J Am Acad Child Adolesc Psychiatry 35:42–50
Cohen J, Mannarino AP (1998) Interventions for sexually abused children:initial treatment outcome findings. Child Maltreatment 3(1):17–26
Cohen J, Deblinger E, Mannarino AP, Steer RA (2004) A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms. J Am Acad Child Adolesc Psychiatry 43(4):393–402
Cohen J, Mannarino A, Knudsen K (2005) Treating sexually abused children:1 year follow-up of a randomized controlled trial. Child Abuse Neglect 29(2):135–145
Deblinger E, Lippmann J, Steer RA (1996) Sexually abused children suffering posttraumatic stress symptoms:initial treatment outcome findings. Child Maltreatment 1:310–321
Kazak AE, Alderfer MA, Streisand R et al. (2004) Treatment of posttraumatic stress symptoms in adolescent survivors of childhood cancer and their families:a randomized clinical trial. J Family Psychol 18(3):493–504
King N, Tonge B, Mullen P et al. (2000) Treating sexually abused children with posttraumatic stress symptoms:a randomized clinical trial. J Am Acad Child Adolesc Psychiatry 39(11):1347–1355
Chemtob C, Nakashima J, Hamada R (2002) Psychosocial intervention for postdisaster trauma symptoms in elementary school children:a controlled community field study. Arch Pediatrics Adolesc Med 156(3):211–216
Jaberghaderi N, Greenwald R, Rubin A et al. (2004) A comparison of CBT and EMDR for sexuallyabused Iranian girls. Clin Psychol Psychother 11(5):358–368
Deblinger E, Stauffer L, Steer RA (2001) Comparative efficacies of supportive and cognitive behavioral group therapies for young children who have been sexually abused and their nonoffending mothers. Child Maltreatment 6(4):332–343
Stein BD, Jaycox LH, Kataoka SH et al. (2003) A mental health intervention for schoolchildren exposed to violence:a randomized controlled trial. J Am Medical Association (JAMA), 290(5):603–611
Cohen J, Mannarino A, Deblinger E (2003) Child and parent trauma-focused cognitive behavioral therapy treatment manual. Unpublished manuscript
Celano M, Hazzard A, Webb C, McCall C (1996) Treatment of traumagenic beliefs among sexually abused girls and their mothers:an evaluation study. J Abnorm Child Psychol 24(1):1–16
Berliner L, Saunders B (1996) Treating fear and anxiety in sexually abused children:results of a controlled two-year follow-up study. Child Maltreatment 1:294–309
Cohen JA (2001) Pharmacologic treatment of traumatized children. Trauma Violence Abuse 2(2):155–171
Fegert J, Herpertz-Dahlmann B (2004) Zum Einsatz von selektiven Serotoninwiederaufnahmehemmern (SSRI) bei depressiven Kindern und Jugendlichen (Editorial). Z Kinder Jugendpsychiatrie Psychother 32:74–75
Asnis G, Kohn S, Henderson M, Brown N (2004) SSRIs versus non-SSRIs in post-traumatic stress disorder:an update with recommendations. Drugs 64(4):383–404
Famularo R, Kinscherff R, Fenton T (1988) Propranolol treatment for childhood post-traumatic stress disorder, acute type:a pilot study. Am J Dis Child 142:1244–1247
Perry B (1994) Neurobiological sequelae of childhood trauma:PTSD in children. In:Murburg M (ed) Catecholamine function in post-traumatic stress disorder:emerging concepts. American Psychiatric Press, Washington, pp 233–255
Harmon R, Riggs P (1996) Clinical perspectives:clonidine for posttraumatic stress disorder in preschool children. J Am Acad Child Adolesc Psychiatry 35:1247–1249
Stein D, Zungu-Dirwayi N, van der Lingen G, Seedat S (2004) Pharmacotherapy for post traumatic stress disorder (PTSD). The Cochrane Library, Issue 4
Seedat S, Stein DJ, Ziervogel C et al. (2002) Comparison of response to a selective serotonin reuptake inhibitor in children, adolescents, and adults with posttraumatic stress disorder. J Child Adolesc Psychopharmacol 12(1):37–46
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Fegert, J.M. Sexueller Missbrauch an Kindern und Jugendlichen. Bundesgesundheitsbl. 50, 78–89 (2007). https://doi.org/10.1007/s00103-007-0111-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00103-007-0111-y